Pathology.
Femoral head necrosis, also known as aseptic necrosis of the femoral head, or ischemic necrosis of the femoral head, is a type of osteonecrosis. Osteonecrosis is caused by damage to the bone trophoblastic vessels due to a variety of reasons, which further leads to ischemia, degeneration, and necrosis of the bone. Femoral head necrosis is a lesion caused by localized poor blood flow to the femoral head due to various reasons, which leads to further ischemia, necrosis, trabecular fracture and femoral head collapse. affects the quality of life and labor ability of patients, and if not treated in time, it may also lead to lifelong disability.
Symptoms.
1.Slow course of disease
Femoral head necrosis has a long course, and there are no obvious clinical symptoms in the early stage, but it can be found only after taking X-rays after feeling painful symptoms. The earliest symptom is hip or knee joint pain, pain can be continuous or intermittent. The pain is especially obvious after exertion or long walking, and often radiates to the groin area or the posterior and lateral hip, or the medial knee joint, with a numbness in the area. The nature of the pain is not serious in the early stage, but gradually increases with the development of the disease, and in severe cases, the affected limbs cannot land and the pain is unbearable. The onset of hormonal medication is usually between 3 and 18 months after taking the medication, ethanol intoxication usually has a history of drinking for several years to decades, and the onset is difficult to determine.
2. Restriction of movement
It is an important sign that the movement is impaired in a certain direction, especially internal rotation. The examination should be performed in a lying position, flexing the knee and flexing the hip 90 degrees for flexion, extension, internal retraction, abduction and internal rotation, and bilateral comparison. With the development of the disease, the range of activities is reduced. In the advanced stage, due to the hypertrophic contracture of the joint capsule, the movement of the hip joint in all directions is severely restricted, the hip joint fuses and hip stiffness appears.
3.Crippling
There are three factors that cause lameness.
First, painful claudication, due to increased pressure within the femoral head in early stage patients, pain around the hip joint, with intermittent claudication, i.e. painful claudication.
The second is mid- to late-stage patients limping due to femoral head collapse, femoral neck shortening, and shortening of the affected limb, sustainability claudication.
Third, pelvic tilt claudication, when one side of the femoral head is necrotic, because the body weight shifts to the healthy side when walking, which gradually leads to pelvic tilt over time, resulting in shortening of the affected limb, and the tilted pelvis can be completely corrected by pelvic exercise.
Principles of postoperative rehabilitation treatment.
In the early stage and the initial stage, training should still be based on static exercises (joint inactivity, maintaining a certain posture until muscle fatigue). And must pay attention to avoid hip inward movement (cross-legged, two-legged,) when lying down between the legs pillow, so that the legs can not be together. Do not turn over to the affected side. When turning to the healthy side, the affected leg should be protected so that the hip is kept slightly out of the booth during the whole movement. After lying on the side, put a pillow between the legs to keep the hip slightly out of position on the affected side. Functional exercise is an effective means to promote early functional recovery, and functional exercise should be mainly active, supplemented by passive, gradually and progressively. When exercising, special emphasis should be placed on not putting weight on the affected limb, and doing the muscle extension and flexion around the hip joint, abduction, adduction and internal rotation, etc., with the prone position being more stable.
Early stage: 0-2 days after surgery
1.Positioning
After surgery, the affected limb should be placed in the straight position and a pillow should be placed under the leg to prevent swelling.
2.Ankle pump exercise
50pcs/group, 4 groups/day. This exercise is important to prevent swelling and deep vein thrombosis and promote blood circulation in the affected limb, and should be practiced carefully.
3.Contraction and relaxation exercises of quadriceps muscle
Greater than 300 times/day. It should be done as much as possible without increasing pain.
3 days after surgery
1.CPM (passive knee mobilizer) 2 times/day, 30 minutes/time, ice for 30 minutes immediately after the exercise (the angle is gradually increased without or with slight pain) Keep the hip slightly out of the booth during the whole exercise.
2.Straight leg raising exercise: 10~20 times/group, 1~2 groups/day.
3.Weight bearing and balance: depending on the patient’s condition, starting from 3~5 days after surgery, weight bearing from 1/2 weight to 2/3 weight to 4/5 weight to 100% weight gradually. The affected leg can be weight-bearing on a flat scale to clarify the feeling of partial weight-bearing. Gradually until full weight-bearing standing on the affected leg is achieved. 5 minutes/time, 2 times/day.
Late stage: 3-4 weeks after surgery
1.Fixed bicycle exercise: light to heavy load and gradually reduce the height of the seat. 20~30 minutes/time, 2 times/day.
2.Resistance knee extension exercise: 10 times/group, 5 seconds interval each time, 4~6 groups of consecutive exercises, 30 seconds rest between groups.
3.Heel lifting exercises.
1-3 months after surgery
1.Static squat exercises gradually increase the angle of squatting (less than 90 degrees) with the increase of strength.
2.Straddle exercises: (front-to-back and side-to-side straddle).
3.Single-leg squat exercises on the affected side: slow, hard and controlled (no shaking) 20~30 times/group, 1 minute interval between groups, 2~4 times/day.